Hemodynamic Changes and Transesopahgeal Echocardiographic Findings of Intravenous Amiodarone Loading in Patients Undergoing CABG / 대한마취과학회지

BACKGROUND: Determining the precise magnitude, duration, and mechanism of hypotension caused by intravenous amiodarone could potentially increase the safety of drug administration to critically ill patients. The objective of this study was to characterize the immediate cardiovascular actions of an intravenous loading dose of amiodarone administered using echocardiographic and hemodynamic measurements. METHODS: In a prospective double-blind trial, 20 patients undergoing off-pump coronary artery bypass graft surgery were randomly assigned to receive intravenous amiodarone (n = 10) or placebo (n = 10). Heart rate (HR), arterial blood pressure (systolic, diastolic, mean; SAP, DAP, MAP), pulmonary artery pressure (systolic, diastolic, mean; PSAP, PDAP, PMAP), cardiac output (CO), central venous pressure (CVP), left ventricular ejection fraction (LVEF) were measured. RESULTS: HR, SAP, DAP, MAP, PSAP, PDAP, PMAP, CO by thermodilution method, CVP, LVEF by echocardiographic measurements was not significantly different in both group. Hypotension requiring intervention occurred in 2 of 10 patients after amiodarone administration and in none of 10 patients after placebo. CONCLUSIONS: Hypotension requiring intervention occurred 20% after amiodarone administration, the cause of these hypotension were thought to be arterial dilatation but was not associated with decreased cardiac output or left ventricular ejection fraction and corrected successfully by intravenous administration of phenylephrine.

Causes of Patient Dissatisfaction with Anesthetic Care / 대한마취과학회지

BACKGROUND: Patient satisfaction with anesthesia is an important outcome of hospital care. The aim of this study was to assess the overall level of satisfaction with anesthetic care and to identify predictive factors associated with dissatisfaction. METHODS: Our subjects were adult in-patients with ASA 1-3 who had undergone an elective operation during the previous 12 months. The major measure of subjective outcome was the overall level of satisfaction with anesthetic care on the first day after operation. Patients were asked to rate if they were 'very satisfied', 'somewhat satisfied', 'neutral', 'somewhat dissatisfied' or 'very dissatisfied'. We also measured other predetermined outcomes, such as nausea, vomiting, pain and other complications. RESULTS: At the time of analysis, our database contained information on 3376 patients. 283 (8.4%) patients were 'very satisfied', 1826 (54.1%) were 'somewhat satisfied', 1119 (33.1%) were 'neutral', 133 (3.9%) were 'somewhat dissatisfied' and 15 (0.4%) were 'very dissatisfied' with their anaesthetic care. The number of postanesthetic factors (81.7%) were greater than the number of preanesthetic factors (8.8%) and intranesthetic factors (9.5%) for dissatisfaction with anesthetic care. The causes of dissatisfaction were postoperative pain (43 patients, 29.1%), postoperative nausea and vomiting (17, 11.5%), sore throat (17, 11.5%), waiting a long time before surgery (9, 6.1%), myalgia (6, 4.1%), back pain (6, 4.1%) and other complications. Strong relations were found between patient dissatisfaction and an anesthetic duration of more than 2 hours, moderate or severe postoperative pain, moderate to severe postoperative nausea and vomiting, and other anesthesia-related adverse events. CONCLUSIONS: This study found that patient satisfaction with anesthetic care is high and identified several factors associated with dissatisfaction that may be preventable or better managed.